Richard Smith on barriers to writing and getting published for authors from low income countries

Richard Smith While teaching two courses on “getting published” in Dhaka I had a marvellous opportunity to gather insights into why researchers from a low income country have problems writing and getting published. Most of the researchers were juniors from ICDDR, B (formerly the International Centre for Diarrhoeal Disease Research, Bangladesh), a well established and highly successful research institute. The courses were very lively and lots of fun – for me at least. There were about 60 participants on the first day and 30 on the second.

The classes produced many compelling reasons for publishing, and the students knew exactly what editors want. Why then were they not writing and publishing more? Each class produced a great many reasons, and then we ranked them – by giving everybody two votes.

The overall conclusion has to be that there is not one reason but many, and the importance of those reasons for not publishing varies from individual to individual. It might also have been that if we had dug deeper to find the real reasons we might have come up with a different set.

High on the list of both classes was poor access to journals and the internet. Everybody did, however, have internet access – albeit often slow. And Bangladesh has been one of the most enthusiastic countries in taking up free access to journals through the HINARI scheme. So perhaps it’s less that the researchers don’t have access but more that they don’t have a culture of regular reading. “Little culture of writing” was cited as a reason for not publishing more–but received few votes.

A Harvard economics professor who attended part of one class because he had trouble getting published in medical journals told me that economists pay no attention to what people say but only to what they do. Doctors, for example, say that they are not influenced by money or advertising but clearly they are. The relevance here is that I asked all of those attending the course to “publish something, anything within 48 hours” and email me a copy of what they published. So far – more than 48 hours after both of my courses – I’ve had nothing, whereas 10 out of 26 Dutch general practitioners completed the same assignment.

Perhaps people are scared. For a professional loudmouth like me blogging is no big deal, but for many people it’s a very bold step to press a button and potentially let the whole world read what you’ve written. “Fear of criticism and rejection” and “lack of confidence” came high on our list of reasons for not writing and publishing, and these anxieties may be particularly acute if you work in a hierarchical culture – which is often the case in low income countries.

Another problem was “not knowing where to submit studies.” They asked me how they could know. I reflected and realised that “instructions to authors” would be mostly useless: journals are not usually specific about what they like and don’t like. You can pick up this information only by having regular contact with the journals, and journals change over time, particularly as editors change. This is tacit knowledge that is hard to come by, and tacit knowledge and skills may be very important in getting published. I think of my father trying to teach me to drive and being completely incapable of describing what was involved: he just did it.

Perhaps it was tacit knowledge the classes wanted when they categorized “lack of knowledge of scientific writing” as an important reason for failure to publish. I gave them some of the standard material on how to write a paper, but I doubt that it’s nearly enough. People need mentors to help them, people who can be beside them day after day helping them line by line. Such mentors are in short supply, and “lack of mentors” was on our list.

“Hard to get started” was another problem, one that most writers will recognize. There is always something else to do – answer an email, make a cup of coffee, ring your dentist, anything to avoid the potential pain of trying to write. I wish that there was a writing equivalent of asking people to draw blindfold. The closest I could come was to ask everybody to write 200 words on anything in 10 minutes. They all did, and nobody said they disliked the experience. Indeed, most liked it a lot, and many wrote something that was compelling. Everybody has a story to tell.

“Time and workload” were other reasons, but I don’t think them important. Rather they are all purpose excuses – like lack of money.

“Having to write in English” was one of the first reasons called out in both classes, but it received few votes. As in India, medical students in Bangladesh are taught in English, and people told us that doctors who are sent a journal with articles in both English and Bangla (which is the same as Bengali) chose to read the English versions. There was also agreement that it’s easier to write scientific articles in English because Bangla lacks a scientific vocabulary.

There was disagreement about discrimination as a problem in getting published. Some thought that there was discrimination against young authors and authors from low income countries, but it wasn’t ranked as a major reason.

In addition to problems writing there were also problems with methodology, getting data analysed, and disputes over ownership of data, but we were now beginning to descend into the less serious reasons that included “aiming too high, lack of enthusiasm, laziness, and complacency.” One Nepalese student summed it all up by saying that writing produced a “low return for all the investment.” What I asked about career advancement, fame, money, and the love of beautiful women? “There are,” he answered, “much easier ways to get those things.” Perhaps that’s the real reason for not writing and publishing.

Competing interests: The UnitedHealth Chronic Disease Initiative that RS directs is funding the creation of a centre to counter chronic disease at ICDDR, B. RS had his fare to Dhaka paid by ICDDR, B because he delivered the keynote address at its scientific conference. Overnight trips in Emirates economy via Dubai would not, however, count as a bribe in anybody’s book. He also had his stay in the guest house funded and his ticket to the Black and White Ball, both of which were very pleasant. He wasn’t paid for running the courses despite quoting Samuel Johnson in the courses as having said “Only a fool writes for any reason apart from money.” He isn’t being paid for this blog either.”

  • I find such as paper a precise analysis of what accounts for the reason some articles are rejected, while others, equally whorthy aren’t.In my opinion, is to be confuted the suspicion about the fact that a Harvard professor may have more chance of publication than , for example, a Genua retired General Practitioner. In fact, the first give exact information about gene mutations, diabetes is based on, whereas the second author speaks about diabetic “and” dyslipidemic Constitutions, Diabetic INHERITED Real Risk, newborn-pathological, type I, subtype b) aspecific Endoarteriolar Blocking Devices, pancreatic microcirculatory remodelling, bedside recognized with a stethoscope in ONE SECOND, due to quantum entanglement: unheard-of!

  • Marije Soeters


    I am one of Richard Smiths “students”, attending his course in the Netherlands. And I must admit I have not completed my assignement to publish within 48 hours.
    Ofcourse I have my excuses ready: my birthday, other paper to finish, general lack of time. But they are what they are: excuses.
    But to define the real problem is not easy. Why did the motivation that you feel after the class slowly fade away?
    is that daily life? (guess this is another excuses.)
    My final analysis is that i really did not know what to write about and where to put it. Too much choice can paralyze you.
    But while i am writing this down, it creeps up to me, this is just an excuse as well.

  • Simon Chapman

    I’ve taught an annual class in public health advocacy to the University of Sydney MPH class every year since 1992. Assessment includes a mandatory letter to the editor of a newspaper on a health topic (worth 5% with an extra 5% if they get it published. My best year saw about 30% of the class (typically 30-50) succeed, but there have been years when only 1 or 2 succeeded. The letters editor of the Sydney Morning Herald often comes in and explains the competition (about 200 minumum received a day, and about 28 published). So one reason is that it takes quite a degree of skill. I’ve had several hundred published over the years, so know the rudiments: timeliness (never submit after 2pm); topicality; no hectoring or lecturing; wit; erudition; irony; paradox; drawing parallels with other events; killer facts — these are just a few.

    But above all, it’s giving priority to such communication — making room in your life to do it, understanding how influential letters and op eds can be. I’ve never had a health minister tell he or she has read by BMJ or Lancet article. But I’ve had several call me up after a letter or opinion piece wanting to know more.

    It’s a good way to start the day. A letter takes about 15 mins to write and manicure. It can be read by 100,000s.

    I teach them

  • Lijing Yan

    As a researcher who have worked in both the developed countries and developing countries, I believe lack of mentors and lack of appropriate incentive system would rank high as barriers for publishing in developing countries. In China, language could also be a real issue.

    I found Prof. Chapman’s blog on publishing letters very illuminating. In terms of reaching policy makers (and the public), letters offer one quick and direct way – something academic papers can not achieve.

  • Niels Rossen

    This thorough analysis by Dr.Smith does point out very important barriers to publishing. As I am one of his class in the Netherlands, I experienced the 200 words in 10 minutes task. It taught me that a lot of the barriers that prevented me from writing until now, can be easily overcome by will alone. A lot of barriers are in our heads I think, and can be removed by instruction and experience. This might not be enough to get publishing for everybody, but I propose that we focus on solutions like these. Personally, I am a general practitioner in training and I think our scientific eduction is insufficiently focused on publishing. I would very much want to be more actively taught in scientific publishing, preferably this topic would be taught just like other practical skills, as for example surgical techniques are taught. If the technique of publishing is considered to be a skill that can be taught, and is experienced to be rewarding, more colleagues will participate.

    Greetings Niels Rossen

  • Jan Schakelaar

    There are many barriers to writing as is shown in the article above and the published reactions.
    For me, a mentor would have been a great help to wake up my dormant wish to write and publish. A mentor who would show me where to publish( a blog is very easily started as I experienced) and how(as Mr Chapman in his respons gives a lot of useful hints).
    The barriers to writing for the Bangladesh researchers seems higher than for the Dutch Gp’s. It is only guessing why. An offer for a structured mentorship could may be of great help for those who want to publish but for whom the hurdle seems to high.

  • Franca Ruikes

    Publishing indeed, as Richard Smith stated, requires ‘dare’; not being afraid of the reactions to your writing, especially if it contains your personal opinion.
    I think this may be one of the main reasons that half of us ‘Dutch GP’s’ did manage to get published within 48 hours, while none of the Bangladesh’ students did.
    In general Dutch people aren’t that reluctant to flutter the dovecote, of which some of our politicians unfortunately are non-flattering examples as the Britisch people recently discovered.

  • Sukhpal S Gill

    I found this to be a very interesting blog with usefully informative responses by respected Sirs. In sharing my thoughts, I apologise in advance if I do slightly deviate the issue from low income authors to UK medical students like myself.

    During my preclinical medical student days, I felt the only proper way to get published was by undertaking a good research project with popular supervisors. Therefore when it came to selecting a Public Health project which is part of the core curriculum at Birmingham med school, I was involved in a race (with fellow students) to choose the best project which required the least amount of work, and had a good chance of getting published. Unfortunately we never did get that 3rd year project published, and although the experience of working with an experienced supervisor was worthwhile, there was minimal guidance on what was required to get that publication.

    Later on, I was fortunate enough to work with a fellow medical student who had some experience of publishing. Those two evenings that we worked together to write an academic letter were enlightening. Apart from the fact that it took me a long time to write, I relished the challenge of putting a great deal of thought in to a concise piece of work.

    I think medical schools could do more to encourage medical students to get published. Perhaps providing options to be mentored by appropriate people through Special Study Modules or arranging for students to submit letters to newspapers like they do it down under. In addition to improving students’ communication skills, people like Peter Watson from Aberdeen, who has written a star letter in the recent BMAnews (21st Feb 2009 issue), will not be disappointed by his medical students mixing up their weather and whether in dissertations.

    In response to the amusing conclusions of the Nepalese student mentioned in Richard Smith’s blog, I don’t agree completely. Granted, beautiful women will not suddenly start showering their love. However, I believe the time invested in getting published (even if the work doesn’t make it to the audience) is worthwhile in developing the skills of writing well under the guidance of useful feedback from editors/readers (much better and detailed feedback compared any examiner marking student essays). With regards to career advancement, the skill of being to the point in a concise manner is invaluable – for instance when applying for posts (such as FY1 jobs) where answering complicated questions concisely is the key to success. Fame and money via commissioned work depends on how well you can write (again dependent on how much time you invest in further developing your writing skills). Although love of beautiful women might not be forthcoming, love of beautiful minds (especially when they constructively criticise your work) is equally rewarding.

  • Sukhpal S Gill

    Correction to my previous entry: please read ‘from low income authors’ as ‘authors from low income countries’.

  • Hello,
    We passed a wonderful time with Richard exchanging our concerns over getting published. Immediately, returning from Richard’s class I changed the tittle of my manuscript to “Retention of BRAC health volunteers: A case-control study”. Previously, it was “Retention of BRAC health volunteers: Role of incentives and disincentives”, and there was no indication of study design in the tittle. Dr. Elizabeth Oliveras, my supervisor who is guiding me in ananlysis of data and writing the manuscript also recommended that it was a good reflection of learning. Apart from this, the class discussed many practical issues of getting published which, I think, is an important progress to removing the fear of writing and sharing with colleagues in future.

  • I would like to thank Dr. Smith for his articulate and lively presentation in the session on “Getting Published” at ASCON XII in Dhaka. I enjoyed the class and learned some technicalities in writing a paper for publication.

    However, I think the students attended Dr. Smith’s class here could not understand that it was really compulsory for them to write something and get published in any journals or newspapers in 48 hours. For me, definitely I could not, as I thought that the assignment for writing 200 words in 10 minutes was the task that Dr. Smith wanted us get published to him. Otherwise, I would definitely send something to any newspapers for publication and obviously there were more potential students in the class who would do so.

    By the way, I will send a letter to the Daily Star in Dhaka today and will be waiting to see it published in 48 hours, though I wonder the daily would do it. The delay in publishing is not always for the quality of the writing, but for their workload and irregularity in publishing letters.

  • Tarique Huda

    I am one of the lucky persons to have the opportunity to attend the course on Getting published held in Bangladesh. It was really a very good course and i feel very appropriate for me when i am struggling to get my first ever paper submitted. I feel its a very lenghty process to get things published in a creddible journal. But course has equiped me to fight against my fear of being rejectedf. Teh fear that what i am trying to write may not be interesting to others. Should thank Dr. Smith an dteh organizers of the course.

    I should confess that i was lazy to do the assignment given during the course. As soon as i finished the cpourse i was involved in sorting out one of the challange my study si facing so writing was less priority for me. I feel this should not be an excuse but probably this is among teh many barriers of getting published that we are so involved in the ongoing and high priority work we keep pending the time allocated to write a manuscript.

    I feel if i can plan and manage my time better i would eb able to publish a manuscript by end of thsi year.

    Thanks Mr. smith for following up for the assignment

  • Mashida Rashid

    I think one of the greatest barriers to writing is forgetfulness, followed closely by procrastination.In short, writers are lazy.
    Having done Dr.Smith’s course in Bangladesh, and thoroughly enjoying it, I am guilty of all three sins.
    Lack of time, mentoring, guidelines, are all valid excuses, but that’s just what they are: excuses. Blogging is a great way to get into the habit of writing, they are fun, you don’t have to sound particularly intelligent or thought provoking, and the only rule is there are no rules.
    I think for people like me structure is like a noose around the neck, and so its nice to take a break from the tedium of scientific writing and just be.

  • Richard Smith

    I’m very pleased to see that some of those who attended my classes in Bangladesh have now been published.

    In the class I shared a long and marvellous quote from Atul Gawande, the Boston surgeon who has written two outstanding books. Gawande offers advice to young doctors in his book “Better.”

    One piece of advice is to write. “Write something. I do not mean this to be an intimidating suggestion. It makes no difference whether you write five paragraphs for a blog, a paper for a professional journal, or a poem for a reading group. Just write. What you write about need not achieve perfection. It need only add some small observation about your world….Most of all, by offering your reflections to an audience, you make yourself part of a larger world.”

    The full quote is some 500 words, and I urge everybody interested in writing to read it. The suggestions to write is included in the afterword to the book.

  • Veronika

    Today all of us in ICDDR,B got a reminder email from Richard for getting published – me too. Yes, the course was interesting and encouraging. Unfortunately, I was sick during this conference. But I really wanted to participate; that is why I was there. However, at the end I missed the exact assignment. And when I was well again and had written an article, I did the wrong thing with it (I sent it to Richard himself, instead of publishing it, which I understand now, was the task).

    By the way, I wrote an article on “Hand hygiene in child care settings”, as I was influenced by some complaints of other mothers in the play-group of my daughter, who found that the child care personnel had no proper hygiene standards. I surfed on the internet and found an interesting article on the topic and just wrote my opinion about it in the context of my experience. The interesting thing is that I got a letter today from the Principal, inviting me to hold a course on hygiene for teachers and helpers in the play-group. I guess, reading and writing about this topic was already half of my preparation for this course…

  • Tracey Perez Koehlmoos

    As the ASCON deputy chair, I would like to thank Richard again for offering his day long course for two days in a row so that the maximum number of authors/would-be authors had the opportunity to attend. In defense of the non-writing students who attended your course I would like to add that many of these authors were out of their usual setting (in Dhaka, perhaps out of their home country and certainly off of the ICDDR,B campus.) There was a frenzy of activity around the ASCON and many of those present were wrapped up in preparing their slides. Where as some scientists are fortuante enough to have a personal computer, many LMIC scientists only have access to their office computer and to the Internet from their office.

    However, now that everyone has been reminded, there are no more excuses! As for me, it is finding/making the quiet time that it takes to write that is the challenge, and know that I should do less running around and devote more time to writing yet do a terrible job of resisting the knocks at the door or the ringing of the phone.

    Thank you again for all of your hard work while in Dhaka.

  • Arunthia Urmi

    During 12th Annual Scientific Conference (ASCON) of ICDDR,B in Bangladesh , i attended a course “getting published” by Richard Smith on 11th February 2009.

    Though it was a course aimed at writing scientific article, but Richard encouraged us to write anything. He also encouraged us to write on BMJ group blogs. It reminded me of my personal blog that i left unwritten for a long time.

    I thought of going back and say hi to my dear blog, and i did that as soon as i finished the course. I did not write anything on BMJ, and of course i had an excuse for that.

    The excuse that i had, is “time”… to write something nice on BMJ group blogs. I could not manage time to write something “nice”, as usual; today when i got reminder from Abid Rahman, ICDDR,B, i thought i will write “nice” things later on, let just write “something” trivial 🙂

    About publishing in scientific journal, my main problem is: not having a mentor. I have written two abstracts, don’t know how to write manuscripts. Even if i manage to write manuscripts, i doubt if i will be able to publish it. There are some problems associated with it which i do not want to share here. However, thanks to Richard to made me write at least “something” 🙂

    All the best for everyone.
    Arunthia Urmi

  • It was an encouraging course for me. I am doing thesis for my MPH programme and I have learnt very helpful tips through this course for writing the paper. For example, I have decided to modify the title of my study and include study design in it. Actually in my proposal, the study design was not mentioned in the title. Thanks Dr Smith.

    Yes, I also feel that a major barrier is ‘getting started’ because I took two attempts yesterday to respond to this blog but could not start for other engagements. Through this course, I came to know that the barriers we discussed in the class are common to all, it has increased my confidence to write more.

  • Sharifa Nasreen

    It was a great learning experience for me to get an overview on different aspects of getting published. Dr Smith has done a great job in providing us with important information that would be helpful for us for getting published. I particularly enjoyed the exercise on barriers to writing and getting published. Many reasons came out that I had not consciously thought about. So, the course was thought provoking for me as I started asking myself why I haven’t published my MPH thesis yet. At long last I have started revising the very first draft of the manuscript I prepared more than eight months back. I hope I will be able to publish it by the end of this year. Thanks to Dr. Smith.
    I didn’t do the assignment to publish within 48 hours. I visited BMJ several times after the course but couldn’t put up the courage to write. But this blog has given the opportunity to write something and getting published.
    I have already written more than 150 words. Not that bad, after all.

  • Sabrina Rasheed

    I did complete an annual report that was due. But it is going thorugh a review process right now. Isn’t it part of publication?

    One of my biggest problems regarding publication is the number of diffrent things I am asked to do in any given day. I try hard to keep up with my subject of expertise but I am required to write proposals for funding and articles for subjects that I did not have time to read enough to figure out what’s out there. I was tought that papers succedd when you address a gap in knowledge but to figure that out you have to do a lot of reading.

    We have problems finding time to read, search for reading material, and a mentor who helps you through the process.


  • Dr. Smiths class to motivate us to write more in bangladesh, did wake us up for those few hours, but again we slipped back to our usual routines of busy schedules and deadlines.

    As mentioned by the doc, many of the students are yeoung researchers who have enthusiasm but lack confiedence. Culturally we also need that somebody to fire the gun at the strating line.

    As a low income developing country reseracher, we face many barriers and have to struggle harder than most people to make a small place in this big world. and motivation will go along way to overcome this…

  • Suchismita Roy

    I have just posted my rapid (in the grand scale of things even ‘rapid’ is relative :))response to ‘Poor nations’ health systems’ It should be up in 24 hrs (fingers crossed)

    From my personal experience, I will say 200 words can cause enough of a guilty conscience for me to subdue my wrath and painstakenly rewrite my response when an error message caused the original to vanish.

    Thanks to Dr. Smith for conducting a much appreciated course!I learnt a lot and my experience at rapid response proves once again that ‘genius is 1% inspiration and 99% perspiration’ .It is my opinion that most of us do not get published because we do not perspire enough.

  • I participated the session on “Barriers to write and getting published” conducted by Prof. Richard Smith. We do not write for lack of confidence and develop a habit of not to write which contributes to reduce confidence more. “Hard to get started” is a problem for many by and large. But lack of confidence is the prime factor which contributes to have difficulties in getting started. I never felt lack of confidence as a barrier when I used to write poems/stories and got published regularly in bangle. When I am in professional life, issues are quite different and the medium is English. Patronization and mentorship, as I feel, can stimulate someone for writing. I can site a practical example. Before few months my supervisor advised me to write an abstract on scale up of health programme for an international conference making experience a way of view point. This was the first time; I sent my own abstract to an international conference. I finished that writing within very short time by adjusting from and retelling the findings of my project using my area which is management. That was accepted for presentation published for the participants. The positive notion of my supervisor helped me to resolve the both problems of confidence and getting started. Lack of Knowledge is not the main point. All of us obviously have some area where we have required extent of knowledge.
    Thank you, Dr. Smith for the wonderful session where I got brain storming to explore my own barriers. I must plough through for overcoming the barriers and grow a habit of writing. As I hope, the tips you provided, will be very helpful to improve my communication skill as well.

  • Paul Fontelo

    1. Lack of a mentor was on the list and in the student responses. I searched and found ‘mentor’ mentioned 12 times within your blog and responses.

    With the Internet available worldwide, why not ‘virtual mentors’? Established authors, especially from developed countries could volunteer to provide guidance to students on generating ideas, writing and help in finding a suitable journal for their paper. Perhaps, a list of volunteers and their expertise can be made available to students and practitioners in developing countries through an online matching program. With word processor tracking, line-by-line help is possible.

    2. Your students, by responding to your blog, have already made the first step in publishing.

  • Arunthia Urmi

    I second Paul Fontelo. A list of volunteers and their expertise through online program would be very helpful for us.

  • Obinna Ogbanufe

    Before attending the health writing skills workshop in Nigeria, i had a lot going through my mind. prof Richard smith was very clear on what it takes to write and what to do when your write ups get rejected.
    This reminds me of the movie i saw with the title ‘Get rich or die struggling’.(Get published or keep writing)
    Hence forth, the only thing i will not write on is that which has not crossed my mind!
    Thanks all the same for the very enlightening and encouraging lectures.


  • There are too many reasons not to write.
    Publishing however is another matter. While they look like a continuum, : we write to let others see our thoughts, they really aren’t. even when obstacles to exposure of such thoughts have not yest existed.
    The good news is that there are far more reasons to do so.
    The world can only get better by more people speaking, in what ever medium, whatever conversation, they find themselves in by choice or default.
    I too, was in the Nigerian class, :(P.S. Mr Smith, its “the literary one”) and I’m glad that someone reminded me with a good push to engage, and continue to do so.
    even if writing is to “understand better what I’m thinking”..It was a valid point, and one I will not forget in a hurry.
    The questions however, still remain unique for people who come from low income countries, and can probably not be exhausted on this page…..fantastic points contributed by many ahead of me…..adding to most of them might be a repetition.
    So I will just say thank you to Mr Smith, and continue on the path he reminded me to stay on.

  • Uzma Rahim Khan

    I attended Richard’s workshop in Pakistan today. I want to share my experience as I review papers. In Pakistan, the barriers are more or less similar to Bangladesh. Perhaps the language barrier is more than what the voting shows. It could be due to the fact that you have asked to vote verbally and people here not accept / acknowledge this barrier publically . Most of the time, I see people can’t able to put their thoughts in English writing, despite the good understanding of the subject. Lack of proper research training is also a major barrier.
    The beauty of exploring world is to observe their problems and seek help and ultimately do wonders for unprivileged (as you are doing Richard).
    P.S. I have a publication in less than 12 hours…

  • rachel Mash

    Well I decided that I would not wait my 48 hours to post a comment, becuase then I wont get around to it!! Thanks Richard for a highly informative as well as empowering session on how to publish . As Thomas the Tank Engine says , now ' I think I can, I think I can, I think I can!!' Cheers

    Rachel Mash

  • Shanbanubanu

    Yes the points made are quite clear,if BMJ can put a list of mentor it would be a great option for attempting to wrire othe rwise things get stuck in the review process and delay causes distance